Immediate Care Business: “Coding Tips for Laceration Repair”

When reporting wound repair, you must consider three variables: the complexity of the repair, wound location and wound size. CPT describes three levels of wound repair, each of which you will report with a different set of codes. The three levels of wound repair are: simple repairs, immediate repairs and complex repairs. This article examines the three levels of wound repair and provides tips on best coding practices for laceration repair coding.

WHEN BILLING A E&m FOR ED AND A LAC REPAIR THEN A DIGITAL BLOCK WHAT MODIFER IS APPORIATE IR IS IT BUNDLED WHEN I LOOK AT THE CCI EDITS ON MEDICARE IT IS MARKED DIGITAL BLOCK CAN BE BILLED WITH MODIFIER BUT MOST INSURANCE STILL WONT PAY AND I GET CONFUSED BETWEEN USING THE 51 OR THE 59 THANKS

If the E&M code is significantly different than the reason the provider is giving the patient the digital block, you would append a 25 modifier to the E&M visit and no modifer to the Digital Block.

These are only examples, please take at face value since I dont personally bill nor code for Digital Blocks & not positive why one would be given but these examples give you a good idea when a modifier should be used and when it should not be used..

Examples:
Patient comes in complaining of infection to a laceration to his left thigh and during the providers exam the patient explains he has severe radiating pain to his R LE and the provider determine a digital block s/b done. Then the E&M code would require a 25 modifier.

***Different ICD-9 would also be necessary and linked appropriately.

Patient comes in complaining of LBP. During the exam the physician reviews patients MRI report and notes a LDDD and determine a digital block is necessary also during the visit to help the patient with his LBP pain. In this “example” A seperate E&M should not be billed since same complaint/location etc.

In your description, I dont think a 25 modifier nor an E&M visit would be appropraite due to the digital block being directly related to the E&M visit.

I am little confused according to the 2016 CPT code for laceration repair it states that Local Anastasia is included does not mention digital block. So doesn’t that mean that a digital block could be charged with a laceration with a modifier? What is the CPT 2016 answer?